diagnosis of lumbar spinal stenosis

Last edited 10/2020 and last reviewed 10/2020

diagnosis

Diagnosis is usually made from a combination of clinical signs from the history, physical examination, and imaging.

  • history
    • age
    • radiating leg pain that is exacerbated by standing up or walking
    • the absence of pain when seated
    • the improvement of symptoms when bending forward
    • a wide based gait

  • physical examination
    • balance impairment
    • neuromuscular deficits in the lower extremities including decreased strength (weakness), sensory deficits (numbness), and absent or decreased reflexes (Achilles tendon and patellar)
    • tests used to assess functional capacity includes:
      • treadmill protocols
      • the gait loading test
      • the self paced walking test

  • electrodiagnostics
    • methods including electromyography is not used routinely:
      • useful
        • when clinical picture and imaging results do not match
        • in differentiating the condition from diseases with a similar presentation e.g. - peripheral vascular disease (vascular claudication), hip osteoarthritis, and spinal cord lesions

  • imaging
    • although imaging provides the most definitive diagnostic information, it is not carried out routinely during the initial evaluation.
      • usually reserved for diagnostic confirmation and procedure planning for patients considering invasive interventions  
    • MRI
      • currently the recommended method for confirming the diagnosis of LSS
      • has a sensitivity of 87-96% and specificity of 68-75% for the diagnosis of LSS
    • CT
      • recommended when MRI is contraindicated or unavailable.

Note

  • an estimated 21% of people with anatomic stenosis on MRI are asymptomatic. Hence history and clinical presentation should be considered together with imaging before a diagnosis is made

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